Commotio cordis?A report of three cases

Hamilton, Sarah; Sunter, J. P.; Cooper, P.

doi:10.1007/s00414-004-0511-y

Cited by 14 publications

(6 citation statements)

References 13 publications

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“…Ischemia is the most likely culprit for this inhomogeneity, but the findings of focal myocardial necrosis and/or fibrosis are common in cases of sudden arrhythmic death and are often assumed to be the cause of re-entry and electrical instability [7,34,35]. Whether MFB falls into this same category remains to be proved, but it certainly is a possibility that must be considered.…”

Section: Discussionmentioning

confidence: 92%

Cardiac pathology in death from electrocution

et al. 2005

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To better characterize the morphologic changes in electrocution, morphologic changes in the hearts of 21 subjects, who died instantaneously of electrocution, were compared to the hearts of decedents with different types of death. Sixteen myocardial samples per heart were processed for histological examination, and sections were prepared with a variety of specific stains. The frequency, location and extent of myocellular segmentation (stretching and/or rupture) of intercalated discs and associated changes of myocardial bundles and single myocells [myofibre break-up (MFB)] were recorded, quantitatively analysed and statistically evaluated. The frequency of MFB was maximal in cases of electrocution (90%). The findings show that MFB is an ante-mortem change and may be a distinct finding in electrocution.

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Section: Discussionmentioning

confidence: 92%

Cardiac pathology in death from electrocution

et al. 2005

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“…In addition, while certain authors require that the diagnosis of commotio cordis is used only if structural damage to the sternum, ribs and heart is absent, 4,9 others have applied the diagnosis in the presence of rib fractures, minor pulmonary interstitial hemorrhage and cardiac bruising, the latter attributed to attempted resuscitation. 10,11 Thus, consistency in reporting is lacking. As well, not every case that has been attributed to commotio cordis has had an autopsy examination, occurring in only 75% of cases in one series, 4 and so cardiac contusion has not always been definitively excluded.…”

Section: Discussionmentioning

confidence: 96%

“…The blood alcohol concentration of 0.218% may have played a role in the death given that alcohol is known to sensitize the heart to catecholamines and cause cardiac rhythm disorders. 10,20 Ettinger et al coined the phrase "holiday heart" to describe the development of arrhythmias during episodes of binge drinking. 21 They concluded that cardiac arrhythmias may be induced by heavy alcohol consumption and prolonged alcohol exposure with possible mechanisms including elevated catecholamines, electrolyte disturbances, repolarization abnormalities with prolonged QT interval, and impaired vagal heart rate control.…”

Section: Discussionmentioning

confidence: 99%

The Spectrum of Findings in Cases of Sudden Death Due to Blunt Cardiac Trauma—‘Commotio Cordis’

Marshall

Gilbert²,

Byard³

2008

American Journal of Forensic Medicine &Amp; Pathology

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Commotio cordis is a term used for cases of sudden cardiac death due to nonpenetrating chest trauma without evidence of underlying myocardial disease or injury. Contusio cordis has been reserved for cases of chest trauma where there is cardiac bruising. Three deaths due to blunt cardiac and chest trauma after vehicle accidents are presented where the only significant injuries were contusions of the heart and fractures of the sternum and ribs. One case had moderate coronary artery atherosclerosis and another had a blood alcohol level of 0.218%. Given that individuals with cardiac bruising, chest trauma, coronary atherosclerosis, and alcohol intoxication may still die of the same mechanisms as in classic commotio cordis, and that these entities represent a spectrum of findings after chest impact, it may be more useful to separate cases into related subcategories: (A) those with no evidence of injury or underlying cardiovascular disease, (B) those with chest wall fractures, chest wall contusions and/or cardiac contusions, and (C) those with underlying cardiovascular disease or the presence of substances such as alcohol or drugs that may reduce the threshold for cardiac arrhythmias. As there may be cases with a number of these factors, a fourth category (D) includes those with a combination of injuries and predisposing factors (ie, categories B and C). Including cases such as these under the diagnostic umbrella of commotio cordis may demonstrate that a wider range of individuals are at risk for death from blunt cardiac trauma than sports-playing adolescents.

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“…Moreover, toxicological analysis in all the cases is crucial. Ethanol sensitizes the heart to catecholamines action and the subsequent production of arrhythmias . Moreover, the presence of arrhythmogenic drugs, as well as an increase in sympathetic activation usually accompanying an assault, releases catecholamine and may predispose individuals to arrhythmias that contribute to commotio cordis.…”

Section: Discussionmentioning

confidence: 99%

Commotio Cordis – A Report of Two Similar Cases

Zheng

Liang

Liu

et al. 2012

Journal of Forensic Sciences

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Commotio cordis is a rare and fatal mechano-electric arrhythmogenic syndrome, occurring mainly during sports activities. The present study describes two similar cases of sudden death caused by commotio cordis associated with homicide. The two decedents were both 15-year-old male teenagers. Both collapsed within several minutes after being punched in the precordial region, as observed by witnesses at the scenes. Although electrocardiograms were not recorded at the scenes or the hospitals, the sudden onset of cardiovascular, respiratory, and neural symptoms were consistent with sudden cardiac death caused by commotio cordis. Autopsy and forensic morphology both revealed no cardiac or pericardiac structural damage, evident lesions of other internal organs, or underlying diseases, along with negative toxicological analysis, conforming to criteria for diagnosis of commotio cordis. The diagnosis of commotio cordis by forensic pathologists is important in deliberating a verdict of homicide, especially involuntary homicide. In rare instances, a death caused by commotio cordis may have a homicide manner of death.

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Commotio cordis?A report of three cases

Cited by 14 publications

References 13 publications

Cardiac pathology in death from electrocution

Cardiac pathology in death from electrocution

The Spectrum of Findings in Cases of Sudden Death Due to Blunt Cardiac Trauma—‘Commotio Cordis’

Commotio Cordis – A Report of Two Similar Cases

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